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- [00:24]
A
A new diagnosis of type 1 diabetes feels like your life just got turned upside down from the person that got the diagnosis and their entire support network. But the truth is, with the right tools and knowledge, you can absolutely learn to manage it and actually thrive. So in this episode, we're going to give you the quote unquote starter kit that we wish every person received in those first few critical days, Steve and I included, and weeks after diagnosis, with practical tips, must know basics, and reassurance that you are not alone. On this edition of the Taking Control of youf Diabetes podcast, I am one of your hosts, Dr. Jeremy Pettis. I am joined as always by my good friend and colleague, Dr. Steve Edelman. And if you're just tuning in, Steve and I both have type 1 diabetes. We were diagnosed when we were 15, so we've been living with this disease for a little while now. Steve founded Taking Control of your Diabetes a little over 30 years. We're both endocrinologists, we do research. So I guess we know this topic pretty well. And Steve, you know the way that we did this, we're gonna do top 10 tips for people first diagnosed with type one, and then we're gonna do the same for type two. And they are different. And I really enjoyed taking some time to think about what I wish I knew or what I could tell 15 year old Jeremy versus what I wish I could tell every parent going through this or every person diagnosed with it right now.
- [01:44]
B
You know what, thinking about this, this is the first time we've ever addressed this time period. We've done the top 10 tips for living with, but never for newly diagnosed. And I think times have changed. You know, when I got Type one to bring up, you know, horror stories, it was, you know, urine testing and that was it. We didn't have the A1C, we didn't have CGM, which we're going to talk about. But I'm glad to say things have changed and that the whole concept of living a long and healthy life with type 1 is totally reasonable. And now we see all these great athletes and movie stars and other role models living successfully with Type one.
- [02:25]
A
Yeah, the normal Joes, everybody can do this. It's only reasonable. It's expected, I think. So that's a key message. I want to say off the top that this is top 10 tips for people who are diagnosed. And we realize that this is very different. You can get diabetes at any age. You can get it when you're two, you can get it when you're 92. Literally. We know now that half the people are actually diagnosed as adults, so it's hard to come in with tips for a 2 year old versus a 92 year old. This is just generally speaking, if a new diagnosis is presented to the family or the patient or the person. Here's some ideas. And these are in no particular order. You know, these are 10 tips. These aren't in order of importance, but here they go. So you ready for number one?
- [03:09]
B
Yeah. And I was just going to add to that that when I was, when I was looking at the list and thinking of the things, I wanted to put everything first. So I'm glad you said that. It is no particular order and once again it is individual. So we hope our comments will help.
- [03:24]
A
So this first one's probably the one that I thought about the most. But my tip number one is get this freak out. And it's controversial for this reason because I thought, you know, should people freak out, should I say like don't freak out and stay calm. But that's not, you know, reasonable. So I have freak out here because it's just acknowledging that this is a life changing diagnosis. There's a lot going on, there's a lot of information that you're being kind of bombarded with and it's okay to feel overwhelmed, to be sad, to be mad, have all these emotions around it. And I remember When I was 15, I was still a kid obviously, but I felt like I immediately had to get a handle on it and just kind of had to figure it out and work through it and never really that I remember had a period that I felt like it was okay to be sad or to think about this in some way. So it's just a way of saying whatever emotions you were experiencing as an individual or as a family is totally okay and expected that this is a life changing thing. And like I think we should start there.
- [04:26]
B
You know what, when I first was diagnosed, I was just ignorant. I wasn't mad, I wasn't glad, I wasn't sad. I just didn't know what was going on. So everyone has their different reactions and I think number one, you know, I put we came up with our list separately, but most of it are on the same list. Is that get diabetes education immediately. And I know I talk about the emotional issues on down the line, but I'm a big believer that knowledge is power and that knowledge will take away my list.
- [04:56]
A
Steve, we're going to go through my list and then you can add ones that I didn't hit. So that was actually Number two on my list. So thanks for blowing that. But number one to keep with my list is freak out again. What I mean by that is, you know, it's for parents too, and for the friends of parents, you know, that like, the parents are going through this and like, it really does send like shockwaves and nobody knows how to respond to this or how to help the person living with diabetes. So just like, it's a way of saying it's going to be like a turmoil, like a time for some people it's no big deal. You know, some people it's a big deal. So it's just, it is what it is and like, allow that to happen.
- [05:32]
B
So number two, not going to freak out on your. Number one.
- [05:36]
A
I agree with you is exactly what you said is educate yourself immediately. And I would say what I particularly mean about this, there's a lot to learn with diabetes. But I think what's important probably most at the beginning is understanding the course of the disease. This is an autoimmune attack on your beta cells. A lot of your insulin producing cells have been destroyed. But there is this thing called the honeymoon period where people, after they get kind of initially insulinized, their beta cells wake up and they start producing insulin. I came off of insulin for almost a year. We've talked about this. Your honeymoon wasn't as great in multiple aspects. You talked about your real honeymoon, this one. But that can really be strange, right? I didn't have diabetes and now I do, but now it's gone again and what's going on. So kind of understanding the natural course of diabetes early on and what that means is that you're going to need insulin initially, you probably will need less for a period of time, but then diabetes kind of comes back and you're going to need a start taking more insulin and things like that. So understanding that kind of expectations and that when you do need more insulin, it's not because you're doing something wrong, you're not eating the right things, that this is the way that type 1 diabetes goes.
- [06:54]
B
Yeah. And I still remember in training they would say if your patient, especially younger people that come off of insulin, continue giving them some insulin, so they don't think that their diabetes is gone, continue to get shots, but. And everyone's different. My honeymoon really was not very good in many aspects, as you said. And. But it also opens the door, this whole topic for research. And we'll get to that.
- [07:20]
A
Yes, we will. Thank you, Steve, for putting your stupid list. All right, so, you know, I Said education. There's so many things, you know, like, that's overwhelming to some people. Like, is there a top thing that you would say people need to like, really read up on when they're first diagnosed with type one?
- [07:37]
B
Well, I just want to say one more thing. I think education is probably the single most important thing you could do when you're newly diagnosed. You mean in terms of the. I would say, you know, right at the top of the list, educate the best ways to treat yourself, let's say with insulin. And we can talk about the basics of insulin. You know, the long acting insulin that covers you overnight in between widely spaced meals, and then fast acting insulin that you take with meals and to help correct your blood sugar when it is too high. So we call that the basal bolus approach. And that's probably what everyone gets put on initially.
- [08:17]
A
Yeah. And I would say as you're saying this, it's really like all of a sudden you gotta become an expert in two major topics. One, immunology. What's going on with the autoimmune attack on my beta cells and what's going on there and why did that happen? And then two is the repercussions of that is the metabolic side of it. When you don't have insulin, how do you replace it? What does insulin do? There's just a lot you learn kind of up front and you don't need to just sit there and read hours on end, but just slowly educate yourself and find the right sources. So obviously, tco ID one stop shop for diabetes stuff. But to pat ourselves on the back to endocrinologists, we have a reputation here. Make sure you're listening to people like us. And it's not Susie on Facebook that told you you can cure yourself if you eat cinnamon, you know, or whatever.
- [09:09]
B
Cinnamon buns.
- [09:09]
A
Cinnamon buns. Yeah.
- [09:10]
B
Yeah, you could kill yourself.
- [09:13]
A
All right, so, Steve, number three on my list, which is really the list, to be honest, is let's just do
- [09:21]
B
your list and I'll let you know what I think you may have.
- [09:24]
A
Yeah, we talked about it an hour before the podcast and you agreed, so let's stick with that. So number three is keep doing the things that you love. And I think this comes up not necessarily like day you're diagnosed, but pretty shortly after that. You know, diabetes affects everything. Our blood sugars. You're worried about going low. Sometimes people will stop exercising, for example, or they'll completely omit carbohydrates, or God forbid they stop drinking alcohol, which is a real sin. But like, there's ways to mitigate all these things.
- [09:54]
B
When I was 15, I stopped having sex.
- [09:57]
A
So worried about drinking. You were ahead of your turf. But what I mean by that is that you can do all these things. So I think when people are first diagnosed, there's like a little bit of woe is me that it's appropriate. Like, am I going to be able to do the same job? Am I going to be able to do the same exercise? Am I going to be able to. I'm joking, but I still drink alcohol or do these things. And yes, and the answer to diabetes in general is everything in moderation, like you would if you didn't have diabetes. But generally speaking, you can do essentially every job. We just did a podcast with a commercial airline pilot who was one of the last. That's one of the last bastions of things that we were told we couldn't do as people having Type one is being a commercial airline pilot. And now you can, I mean, think of anything. There's literally people at Type one that have climbed Mount Everest and they're NFL players and NHL players and all these sports and all these different professions. So acknowledge that there's going to be a learning curve to figure out your body and your blood sugars, but you can still do everything that you were doing. And you might actually even be better at it. Like learn a little bit more about your body with exercise or empathy at your job. It's why Steve and I went into medicine. It's been kind of a gift in that regard. So keep doing the things you love. Any comments there?
- [11:13]
B
Well, I would just say that you're right. Things have changed. They used to tell women, don't have kids. They told me all kinds of crazy stuff. But you're right, you can do anything you want in life. And you could eat anything you want in life. Just watch our Burrito Challenge and our Donut Challenge. As long as you know how to control your blood sugars while you do those things. And I would say this, Jeremy, looking at your career and mine and many others, others who have Type one, they've used it as a center point to not only improve their career, but also help others. Type 1. So it's been a blessing for me. I mean, I don't know what I'd be doing if I wasn't an endocrinologist.
- [11:51]
A
You wouldn't know me.
- [11:52]
B
What would you think I would be?
- [11:54]
A
Maybe, I don't know. Hairstylist.
- [11:58]
B
Yeah, look at this.
- [12:00]
A
So, yes. So people with type 1 diabetes can do anything and actually, like you said, it can help them excel at it. Like, we are absolutely better doctors because we are living with this disease. And you don't have to be that specific. I have diabetes, so I'm going to be a diabetes doctor. We've met all kinds of people that are honestly, better real estate agents or better like, you know, like podiatrists or whatever they end up doing because they have this, you know, empathy and this condition that they're living with that helps them interact with others, et cetera.
- [12:28]
B
Yeah. And very similar to the podcast that we're going to do for people with newly diagnosed type 2. You know, it makes. Just getting diabetes makes you and your healthcare professional more aware of keeping a better track of your health. Make sure your blood pressure is good, your cholesterol is good, and normally you would never even test and may go years and years out of control. So it does help with overall health as well.
- [12:51]
A
And this is something we say all the time, but every time I say it, you know, people like to hear it. It's worth repeating. People with type 1 diabetes are living longer than ever and even longer than people without diabetes. And that is another, let's call it a gift of type 1 diabetes, that it does make you more conscious of your health, of seeing your doctor of not just my blood sugar control, but my cholesterol, blood pressure, these kinds of things, the ways I live my life. So there are some benefits from it. So I guess number three became keep doing the things you love, slash, diabetes can be a positive thing. Number four, this is one I guarantee was on Steve's list is get a continuous glucose monitor. So, Steve, you want to talk about that?
- [13:33]
B
You know, I hope that if you're newly diagnosed, you already have one, because in the olden days, they'd say, oh, make someone wait, prick your finger, gives you a blood sugar.
- [13:43]
A
You know the basics. Like, you gotta, like, go through the ropes first.
- [13:45]
B
And you know what? That was a tremendous advance from urine testing. But a continuous glucose monitor, I mean, measures your blood sugar frequently. You get a value every five minutes. You get trend arrows to warn you when you're going too high, and you get trend arrows to warn you before you get low. And we'll talk about that separately. And it can tell you how your body reacts to exercise, different foods, and especially insulin that you're going to be starting and not really know if you're on the right dose yet. And it is just probably the single most important tool you can have. What do I usually say? That is the single Most important advance in type 1 diabetes since the discovery of insulin.
- [14:27]
A
Right. So I guess the second greatest advance overall. Yeah. But yes, since insulin, since 1921, I guess the second.
- [14:33]
B
You're right.
- [14:34]
A
100 years. So yes, get a CGM. If you haven't heard about it, for God's sakes, ask your provider if they've offered it to you and you've declined it. I'm sorry, but you got to get over it. You know, like some people will still say, I don't want something on my body. Like you simply cannot control your blood sugars well, and stay safe in diabetes type 1 or type 2 without a CGM. So it's something that we're, Steve and I are very opinionated on because we lived through the era when you couldn't get it. And even when they were available, you still couldn't get them. And so we realize how fortunate we are to have these tools and they're life changing.
- [15:07]
B
And insurance companies are smart enough now to approve it for every type one. And we have choices. We have the Libre, we have the Dexcom, we even have an implantable one called the Eversense365. So pick the one that fits your lifestyle the best.
- [15:21]
A
Absolutely. All right, so number five is know and believe your blood sugar goals. So we just talked about cgm. So we now have like, we know what we want your average blood sugar to be generally 150 or less. We want your time and range. That's the time between 70 and 180, 70% or more. And I find a lot when people are first diagnosed, especially when they're honeymoon period, their time and range is 95 to 100%. And they can start believing that that's where they should be all the time. But trust us that if you keep your blood sugars in your timing range 70% or better for the rest of your life, you're going to just do completely fine. I mean Steve and I, Steve was diagnosed in 70.
- [16:11]
B
Yeah.
- [16:11]
A
One shot of insulin, no CGM, urine testing. And mine wasn't that much better, but our blood sugars were all over the place and we didn't even know about it and we're doing okay. So if you keep your blood sugars in that range and don't put these arbitrary intensive goals on yourself, that I gotta be perfect. You will thread that needle and find the place where you can mentally be sane. You know, like I'm doing a good job with diabetes and I'm not like having a panic attack about it. I'm Doing okay, and you're medically in a safe place, that's the place to be. And that's if you're 70% or above, you're nailing it. So don't just try to drive yourself crazy with, like, imposing these, like, some rule of perfection on yourself, you know, that's so important.
- [16:53]
B
I mean, the experts that came up with the 70%, you know, realize that that's equivalent to an A1C of 7. And we know from years and years and decades of research that's a safe level. And I think it's important to say here, especially if you're newly diagnosed, that when you look at your lab slip from the hospital, what they list for your A1C is what it should be if you do not have diabetes. And that is a big issue for people because it says normal is less than 5.7, and we have people saying, oh, I gotta get less than 5.7. And that's dangerous because you're gonna have a lot of lows. And I wish they had two sets of values, one for people without diabetes and one for people with diabetes. And the one that for people with diabetes should be less than 7%. And, you know, if you're 7.2, it's nothing to panic over at all, and it's important. I'm so glad you said that. I didn't really go into that on my list, so kudos to you.
- [17:49]
A
Yeah, well, I'm glad. Well, and, you know, to kind of nail that down, like, you know, the whole name of the game is not to have a perfect blood sugar or to look at your CGM and feel good about that particular number. The name of the game is living a long and healthy life with diabetes. And that means avoiding complications. But that also means maintaining your mental sanity. And we know that if your A1C goes from 11 to 10, that you've drastically reduced your risk of complications. If it goes from 10 to nine, another drastic reduction in complications. Nine to eight, pretty good. But after eight, it starts to flatten out, which means if you go from 7.5 to 7.4 to 6.5, it becomes less monumental. So we picked this number of seven after years of research and research that's been confirmed showing that that is a safe place, that if you maintain that or around there, you are in a safe place. And it's also keeping you relatively low risk of low blood sugars, because what happens if you try to get a 5.7? You're gonna have a seizure, you know, from having too much insulin. And being hypoglycemic.
- [18:58]
B
Yeah. And we know people like that. You know, the other thing to mention is that, you know, good control is hard to maintain 24, seven, you know, and you're gonna have periods of time when your control isn't perfect, but it takes years and years and years of high blood sugars to develop complications. So don't freak out if for this next weeks or a month, you just have a hard time emotionally, physically, and your numbers are higher than you, than the 70% or your timing range is lower than that. So I would say, remember, you know, diabetes changes over time too.
- [19:30]
A
Yeah. And I would say another way that you know to look at this, that actually Bill Polonsky told me once is like 70% time and range is a goal. That means that 30% of the time you can be out of range, you know, and that is, let me think about that.
- [19:44]
B
It's like seven hours, seven hours a
- [19:46]
A
day, you know, so you're going to go high, your blood sugars are going to be high and they're going to be low. Steve's all over the place. I'm just kidding. But both of us struggle with high ammo. It's very rare, very rare that I go a whole day with staying completely in range. So you gotta just kind of go with the flow. You're going to have the highs and lows. And it's not like every time you go above 200, your eyes are blowing up. It really is more of a marathon. It's about if you do go high, bring it back down in range and get on with your day rather than perseverating on that moment, you know, when
- [20:24]
B
I pull up my CGM download or even on my phone or my monitor. It's a rare day that I do not go above 180. And I would say this, you know, it depends what you eat, but it also depends how long you stay over 180. And what do we call a 24 hour period where you're in exactly an ideal range, 70 to 180.
- [20:47]
A
We call it a no hitter because you're not hitting the low alarm or the high alarm. And I can't remember the last time I had one. Steve's pretty tight control these days. Me a little bit more loosey goosey. But I can't remember the last 100% day I've had.
- [21:01]
B
I'd say it's rare. It's rare for me and it feels good. One time I tried to get my three day average 100% time and range. I'LL be honest, I couldn't do it. But if you can get 70 sometimes I'm in the 80% range. I'm really proud of myself. So remember, and your diabetes control is important, but don't panic. Like you said, if it goes out of control for a short period of time, just figure out what you're doing wrong and get it back in range.
- [21:27]
A
Yeah. Now, I also do want to realize that blood sugars are frustrating. It's easy for us to sit here and say, just don't worry about it. And I always tell the story that I have a hole in the back of my bathroom door from when my blood sugars were high and I just threw my phone because I was so mad and it just broke the back of my bathroom door and haven't fixed it yet.
- [21:50]
B
You got a cheap door.
- [21:51]
A
I know. I'm just really strong and threw my phone really hard.
- [21:55]
B
Did you really?
- [21:55]
A
Yeah. So just to say that, like. And I know you've been there too, Steve, this is really frustrating. So we acknowledge the frustration, but also it's just trying to keep your eyes on the prize that, like, look, I'm gonna get high and I'm gonna get back into range and move on with the day. So. All right, so that was. As a recap. I know you liked me to do this. Number one was freak out or don't. Number two, educate yourself. Number three, keep doing the things you love. Four, get a cgm. Five, know what your blood sugar's goals are. Six different idea here. Consider a clinical trial. So, in general, when people are diagnosed with type 1 diabetes, you still have 10 to 20% of the beta cells that make insulin that are left. And those are what kind of like come back online when you control your blood sugars and cause the honeymoon period. So there is this window of time that you can do something to intervene, to try to dampen the immune system to help keep those cells alive. Now, to date, nothing has been proven. There's no approved medication to do that. Unfortunately, once beta cells die, they're dead. They don't come back. They're like brain cells. So because of that, you have this finite window. And a lot of these new onset type 1 diabetes clinical trials are really aggressive in that window. Some as short as six weeks post diagnosis. Sometimes they go to like, three or four months, rarely to a year after diagnosis. So you really do have this kind of short time when granted, a lot is for you to know about these clinical trials. So if you've been recently diagnosed or a loved one, this is where you have to be very proactive. A lot of times these aren't offered. People don't know about them. Start by asking your particular provider if they don't know, calling literally the university that's closest to you. Ask for their endocrinology department. See if they have clinical trials going on. Formerly JDRF, now breakthrough T1D has a clinical trial finder where you can type in where you live, your zip code, how far you're willing to travel. Kind of like some of your metrics. You're newly diagnosed and it's reasonably good in terms of giving you clinical trials in your area. But this is something good news or bad news, you gotta be really kind of aggressive about because no one's gonna hand this to you on a silver platter.
- [24:08]
B
Yeah, just like our video we did, it's a critical time period and you want to get to those beta cells that are being destroyed and stop the destruction so you can prolong your honeymoon. And there's so much we don't know about it. And, you know, you're working with all the companies and there's a list of them now, and they all have different approaches. So I think, you know, we're going to see when we do this podcast a year from now, we're going to have a lot more information and we'll be discussing it at our one conference in mid August in San Diego too. So I'd say it's an area that I've never seen such advances in such a short period of time.
- [24:48]
A
Totally agree. All right, so number seven, involve your support network. And I said involve, because this can take all shapes and sizes. So you're diagnosed, you're an adult, maybe you're a kid, whatever. Like, everybody's kind of freaking out. You know, eventually people need to kind of meet back up six months after diagnosis, a year after diagnosis, and talk about what they can do to kind of help each other. A lot of times it's what can I do when your blood sugar's low? What do you want me to ask you or not about your blood sugars? This is particularly meaningful for parents sometimes where they're just hyper focused on the kid. What's your blood sugar? As soon as they walk through the door, what's your blood sugar? How you can be helpful or not actually having those conversations, rather than, my blood sugar's low and I need something and you never help me and you don't love me. You know, those kinds of things. Talk about it in a situation where it's not like A red alert. It's a calm situation. And realizing this has been. It's never going to be as hard as it is on the person living with that. Let's be clear about that. But everybody's trying to help. And what is the best way that they can be helpful or not? You know, like, here's some things I don't want you to comment on, I don't want you to be involved in, but, man, it sure would be nice if you carried some Skittles around for me. Me, I don't know, whatever it might be. We do this a lot at tcyd. We've done this Newlywed Game where we have couples that have been. One person has diabetes, the other doesn't. They've been married together for a short time or a long time or whatever it is. And there's just so many common themes about. Everybody's trying to support their loved one, but they don't know how. And generally these conversations aren't had. The person with diabetes wants the other person to butt out, but when they don't get involved at the right moment, then they resent them for it. It's like this crazy dynamic. So this is something that. To call attention to that it takes time and energy and work to make it work with your support network.
- [26:54]
B
You said the magic word. Have a conversation, have a discussion. You always give that to me when I come to you with my own issues at home. But I think a great example of that is who. Who or anybody is going to follow you on your cgm. You and I have discussed our significant others. We'd rather them not follow us and make comments because we just don't need it, we don't want it. And other people, it's really important to them.
- [27:20]
A
Well, Steve, I used to follow your blood sugars. I don't know if you do, but then if he would get low, he said you would see who texted you first to see if you were okay and you would rank your friends based on that. I didn't want that pressure anymore anymore, so I unfollowed you.
- [27:34]
B
You know, that's a joke. But.
- [27:36]
A
But, you know, it's actually, it was pretty great. I could see your blood sugar is low. And then I also, like, you share your location with me. So I could see where you were, you know, and you're low. And if you didn't answer one time you were in Kenya on like, a safari. And I tried calling that, like, hotel that you were staying at because I could zoom in on, like, where you were. So you Were fine. You were just asleep.
- [27:54]
B
But the time that you texted me and told me what I was gonna order on the menu of the restaurant in Phoenix, Arizona, and I thought, oh, my gosh. Yeah, you know what? Once again, though, you know, depends on your age and your preference and your knowledge and your significant other if he or she freaks out too much. So it's just a great example of having a discussion. Say, listen, you know, when you see me get below 55, which is the, you know, that's the lowest level that they can get alert at. You know, look, I'd say I tell people that follow me, look at the trend arrow. If it's straight across, don't do anything. If it's going down, you could text me. And if I don't respond and it doesn't flatten out, then you can call Jamie or text her. So there's a plan. Yeah.
- [28:42]
A
And I was gonna say, this plan can evolve, especially again, as it's kids getting older or even relationships. You know, this isn't set in stone like things can change. Here's how you can be helpful. And it all starts from a place of this person's trying to help. Bill coined the phrase the diabetes police and the diabetes criminals. And it can start to feel like that, you know, somebody's policing you and you're the bad guy. What did you eat? You know, why'd you do that? Why'd you go low? Why'd you go low?
- [29:07]
B
You know, why'd you go high? What'd you eat this time?
- [29:11]
A
And what they're saying is, when I saw that number, it concerned me, and I'm here to help. But it certainly doesn't sound like that. So you gotta get to the bottom of that.
- [29:19]
B
You've turned in such a touchy feely guy. You know, it's important stuff. So I'm impress always say it always comes from a place of love.
- [29:27]
A
It does. And it just doesn't feel like that in the moment. Okay, number eight, get a quote, unquote, good provider. And what I mean by this is you're probably assigned an endocrinologist. I don't know, after you're diagnosed, if you're lucky. Yeah, maybe this. Well, first of all, get an endocrinologist and go see them. And generally, like in an area or at like a hospital or a system like UCSD, there's like one, maybe two people that are like, specialized in type 1 diabetes, if you're super lucky. Endocrinology is a very broad field. We have people that specialize in Bone health and thyroid disease, adrenal disease, pituitary disease, and God bless those people. But they don't know anything about type 1 diabetes.
- [30:09]
B
I hope they're not listening. My colleagues aren't listening to us right now.
- [30:13]
A
But it's hard to keep up with technology and things like that, so it's not a knock on them. So you want to call around who's the guy or woman that really kind of like, this is their thing. And with remote telehealth, like, you can really expand your network. It could be completely, like, within the same state. So don't feel locked into whoever you initially were assigned to. And that might not be your MD also. That's kind of your person. We work with a lot of nurse practitioners or PAs or diabetes educators, but find somebody that you really relate to. Like, you have good conversations with. You feel like. Like it's beneficial to you and not the kind of what did you eat? Kind of mentality.
- [30:52]
B
Yeah. You know, do your own research. Ask your friends and colleagues that may have type 1. Even JDRF, your local breakthrough T1D office may have some recommendations. You and I, we know a lot of them. But also one suggestion that I always tell people, if you can talk to a Dexcom representative or Elite or Abbott, they know all the great type 1 doctors because they're selling CGMs to them. You know, So I was gonna say,
- [31:21]
A
even if you've been seeing somebody for years, feel free to change. People always say, I don't want to hurt their feelings. I mean this in a loving way. We could care less. You know, we have our patients that we, like, love and adore for years and years. No, I could care, you know, like. Well, maybe like Steve, but, like, we just. We don't take it personally.
- [31:36]
B
Yeah.
- [31:36]
A
Like, you know, like, not every relationship, like, works out all the time. Like, people want to, like, change, like, whatever. And like, this is. You're paying for this service. You should go see the person that you find is a vet fit. And do not worry about hurting your provider's feelings. And if you don't like them, then screw them and hurt their feelings. Yeah.
- [31:55]
B
And I think one question for your healthcare professional. Do they watch tcoid? Do they watch Jeremy and myself? Yeah. How much do they care if they never heard of us? Get a new doctor.
- [32:06]
A
All right, number nine, I haven't touched on this at all, but in terms of diet, people freak out about this. What should I eat? What should I not eat? There is no diabetes diet. Again, we should all eat. Like, we all should in terms of overall health, however, type 1 diabetes tends to respond to lower carb diets. Doesn't mean zero carb. It doesn't mean going crazy. But if you want to kind of like make your transition into type 1 diabetes a little easier, it's limiting carbs. And if you want a number, I would say 30 grams of carbs as an adult or less per meal is pretty low carb. And it makes it just much easier to get your insulin dosing right and stay in range and things like that. And yeah, by all means, you go on vacation, blow that out of the water, eat whatever you want. But in General, most type 1s gravitate toward a lower carb diet. Not because it's what we want to do, but it just, it kind of makes things easier.
- [32:59]
B
Yeah, you know, I mean, that was one of the things I focused on too. And you should learn carbohydrate counting. I mean, I resisted for a long time because I did things by creature of habit because I've had type one so long. But it does help you quite a bit, whether you're on the daily shots or a hybrid closed loop pump that you may go for quite early after diagnosis. And it's always quite helpful to count carbs. So we have this thing called the insulin to carbohydrate ratio. It helps you dose your insulin. It's just a way to start off. And it's true, Jeremy. Lowish carbs is the best way to get under to stay in control. And you used to talk about conferences if you're really out of control, not newly diagnosed, but diabetes of long duration. Just really go on a super low carb diet, get back into control, and then slowly add them back into your diet.
- [33:51]
A
I still think that's the way to go when things are, like, really going haywire. For me, it's like, all right, I'm gonna like, like, I'm not gonna go for the french fries tonight or whatever. I'm gonna do my stupid lettuce wrap burger and get back on track. And sometimes, to be honest, that really resets things. Your insulin resistance changes. Like, you just get kind of back in the groove, and it can help you. So all these things are fluid. If you go low carb doesn't mean you gotta be that for the rest of your life. These things, you gotta figure out what works for you. Which I think is a central theme of this top 10 and number 10, which we've already talked about a little bit. But it's basically as much as you can because number One was freak out. Number 10 is try to stay positive as much as you can. There are some positive that comes out of type 1 diabetes. You were handed a bum deal with type 1. Most type 1s in there are the only one in their family that has Type one. I don't have anybody else in my family. Steve doesn't. So you can kind of feel like, why me? But there are some positive things that can come out of it. You're going to learn a lot about medicine, whether you like it or not. And I'm not talking about just the physiology, but how to get your freaking prescriptions filled and all that kind of like crap. You're going to become an expert in insurance companies. But I learned a lot about your body, about health, about empathy for others. It can really help solidify relationships. Steve, I love you to death. Not just because you have Type one, but it doesn't hurt. Every time I see somebody walking outside with an Omnipod or cgm, I have to like a dog on a leash where Chloe pulls me back, like, don't go talk to him. You know, you just want to, like part of the club. You're part of the community. Yeah. And it's a really good community to be a part of, to be honest. So there are some positives and it's hard to feel that way when you're staring at a 300 plus blood sugar, but hopefully there's some moments of reflection that there's some positive things here.
- [35:38]
B
Yeah. Well said, Jeremy. And I would just add to that that living with type 1 diabetes in 2026 things are good. Use it to your advantage, Stay healthy, teach others, and don't let it limit anything you want to do in life.
- [35:54]
A
Yeah. It's much different than 1896 when Steve got type one. So we're glad that we've come so far. But I would say in all seriousness, Steve, you and I are doing really well and there's a lot of people out there that are doing well and there's a lot of people that are struggling. But we Hope this top 10 has been helpful. Please provide comments, things like that. We were just talking earlier that we love getting those. It's less about the views and more about, like, we like to hear what people think about this. So please do write comments, but do like it, do share it all that, that matters a lot in terms of keeping us going and also emotionally, but also to show that people are actually listening to this and enjoying it.
- [36:36]
B
Yeah. And if you have a question that you need an answer, send it along Steve's phone number. We will respond. We respond to all questions, every single one.
- [36:45]
A
So thanks for watching or listening. And if you were so inclined, we're going to have the type 21 coming up next. We're going to record it right now. I don't know where it's going to drop, but that is going to be a lot of fun that Steve's going to lead. So we'll actually follow Steve's list on that one. And I will be quiet. All right. So thanks, everyone.
- [37:02]
B
No way. Take care,
- [37:11]
A
Sam.